Evaluation of Third Molar Impaction Pattern in Orthodontic Patients with Different Skeletal Malocclusion, Southeast Iran
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Abstract
Introduction: This study investigated the third molar impaction pattern in orthodontic patients with different skeletal malocclusions. Materials and Methods: This cross-sectional study focused on lateral cephalometric images of orthodontic patients with confirmed third molars. Data was collected using a two-part checklist that included patient demographics, clinical examination results, and cephalometric findings. Analysis was performed with SPSS version 27 and the chi-square test at a significance level of 0.05. Results: Most third molars were found to be mesially impacted (P < 0.0001). Tooth impaction levels relative to the lower seventh tooth were classified as class C, with the most common relationship to the ramus being class I. Wisdom tooth impaction toward the ramus was significantly associated with the ANB angle on the left side, the WITS score, and vertical facial height on both sides, but not with the gonial angle. On the left side, a significant relationship existed between the wisdom tooth level and the WITS scale. Additionally, the impaction angle correlated significantly with the ANB angle on the right maxilla, the WITS scale on the left mandible, and vertical facial height on both the left mandible and right maxilla. Conclusion: Impacted third molars with the mesiangular angle being the most prevalent. Most patients had Class I malocclusion. A significant association was noted between wisdom tooth impaction toward the ramus and the ANB angle on the left side. Additionally, the level of the wisdom tooth relative to the seventh tooth showed a significant relationship with the Wits appraisal on the left side. Keywords: Third molar impaction; Orthodontic patients; Skeletal malocclusion.
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2. Ishwarkumar S, Pillay P, Haffajee M, Satyapal K. Prevalence of impacted third molars in the South African Indian population of the eThekwini Metropolitan Region. South African Dental Journal. 2019;74.
3. Idris AM, Al-Mashraqi AA, Abidi NH, Vani NV, Elamin EI, Khubrani YH, et al. Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation. The Saudi dental journal. 2021;33(4):194-200.
4. Bamdadianf T. Evaluation of impact teeth prevalence and related pathologic lesions in patients in Northern part of Iran (2014-2016). J Contemp Med Sci| Vol. 2018;4(1):30-2.
5. Kan KW, Liu JK, Lo EC, Corbet EF, Leung WK. Residual periodontal defects distal to the mandibular second molar 6–36 months after impacted third molar extraction: A retrospective cross‐sectional study of young adults. Journal of clinical periodontology. 2002;29(11):1004-11.
6. Motonobu A, Hidemichi Y, Eri U, Takashi T, Kenichi K. Cohort study of pain symptoms and management following impacted mandibular third molar extraction. Oral Diseases. 2017;23(1):78-83.
7. Celikoglu M, Kamak H. Patterns of third-molar agenesis in an orthodontic patient population with different skeletal malocclusions. The Angle orthodontist. 2012;82(1):165-9.
8. Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Van Sickels JE. Third molar surgery: Past, present, and the future. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021;132(5):523-31.
9. Vranckx M, Fieuws S, Jacobs R, Politis C. Prophylactic vs. symptomatic third molar removal: Effects on patient postoperative morbidity. Journal of Evidence Based Dental Practice. 2021;21(3):101582.
10. Khouri C, Aoun G, Khouri C, Saade M, Salameh Z, Berberi A, et al. Evaluation of third molar impaction distribution and patterns in a sample of Lebanese population. Journal of Maxillofacial. 2022:1-9.
11. Riedel RA. A review of the retention problem. The Angle Orthodontist. 1960;30(4):179-99.
12. Tassoker M, Kok H, Sener S. Is there a possible association between skeletal face types and third molar impaction? A retrospective radiographic study. Medical Principles and Practice. 2019;28(1):70-4.
13. Yilmaz S, Adisen MZ, Misirlioglu M, Yorubulut S. Assessment of third molar impaction pattern and associated clinical symptoms in a central anatolian turkish population. Medical Principles and Practice. 2016;25(2):169-75.
14. Joshi N, Hamdan AM, Fakhouri WD. Skeletal malocclusion: a developmental disorder with a life-long morbidity. Journal of clinical medicine research. 2014;6(6):399-408.
15. Husain S, Rengalakshmi S. Correlation between mandibular third molar and mandibular incisor crowding: A retrospective CBCT-based study. J Dent Res Dent Clin Dent Prospects. 2021;15(4):247-50.
16. Palikaraki G, Mitsea A, Sifakakis I. Effect of mandibular third molars on crowding of mandibular teeth in patients with or without previous orthodontic treatment: a systematic review and meta-analysis. Angle Orthod. 2024;94(1):122-32.
17. Gokalp H, Erdem M. Assessing position changes of impacted third molars in treatment of class II malocclusion with premolars extraction. Acta odontologica Scandinavica. 2024;83:582-7.
18. Shokri A, Mahmoudzadeh M, Baharvand M, Mortazavi H, Faradmal J, Khajeh S, et al. Position of impacted mandibular third molar in different skeletal facial types: First radiographic evaluation in a group of Iranian patients. Imaging science in dentistry. 2014;44(1):61-5.
19. Hassan AH. Pattern of third molar impaction in a Saudi population. Clinical, cosmetic and investigational dentistry. 2010;2:109-13.
20. Novianty S, Melynda V, Yusuf M, Putranto R. The Relationship of Facial Soft Tissue A’N’B Angle and Facial Hard Tissue ANB Angle in Determination of Skeletal Relations. Odonto : Dental Journal. 2023;10:34.
21. Gasgoos S, Saleem N, Awni K. Cephalometric features of skeletal Class I, II and III (A comparative study). Al-Rafidain Dental Journal. 2007;7:122-30.
22. Cortell-Ballester I, Almendros-Marqués N, Berini-Aytés L, Gay-Escoda C. Validation of a computer-assisted system on classifying lower third molars. Medicina oral, patologia oral y cirugia bucal. 2011;16(1):e68-73.
23. Prajapati VK, Mitra R, Vinayak KM. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dental research journal. 2017;14(2):137-42.
24. Aryan Hesam A, Seyed Morteza S, Reza G. Molar impaction patterns and skeletal malocclusions. Journal of Craniomaxillofacial Research. 2022;8(4).
25. Sivaramakrishnan SM, Ramani P. Study on the prevalence of eruption status of third molars in South Indian population. Biology and Medicine. 2015;7.
26. Al-Anqudi SM, Al-Sudairy S, Al-Hosni A, Al-Maniri AJSQUMJ. Prevalence and pattern of third molar impaction: a retrospective study of radiographs in Oman. 2014;14(3):e388.
27. Al-Madani SO, Jaber M, Prasad P, Maslamani MJMA. The Patterns of Impacted Third Molars and Their Associated Pathologies: A Retrospective Observational Study of 704 Patients. 2024;13(2):330.
28. Syed KB, Zaheer KB, Ibrahim M, Bagi MA, Assiri MAJJoiohJ. Prevalence of impacted molar teeth among Saudi population in Asir region, Saudi Arabia–a retrospective study of 3 years. 2013;5(1):43.
29. Gupta S, Bhowate RR, Nigam N, Saxena SJISRN. Evaluation of impacted mandibular third molars by panoramic radiography. 2011;2011(1):406714.
30. Jung YH, Cho BH. Prevalence of missing and impacted third molars in adults aged 25 years and above. Imaging science in dentistry. 2013;43(4):219-25.
31. Singh P, Nath P, Bindra S, Rao SS, Reddy KVR. The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study. National journal of maxillofacial surgery. 2018;9(2):215-21.
32. Ryalat S, AlRyalat SA, Kassob Z, Hassona Y, Al-Shayyab MH, Sawair F. Impaction of lower third molars and their association with age: radiological perspectives. BMC oral health. 2018;18(1):58.
33. Passi D, Singh G, Dutta S, Srivastava D, Chandra L, Mishra S, et al. Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study. National journal of maxillofacial surgery. 2019;10(1):59-67.
34. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F. Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Medicina oral, patologia oral y cirugia bucal. 2013;18(1):e140-5.
35. Alfadil L, Almajed E. Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. The Saudi dental journal. 2020;32(5):262-8.
36. Carter K, Worthington S. Predictors of Third Molar Impaction: A Systematic Review and Meta-analysis. Journal of dental research. 2016;95(3):267-76.
37. Aldrees AM. Pattern of skeletal and dental malocclusions in Saudi orthodontic patients. Saudi medical journal. 2012;33(3):315-20.
38. Ran ALY, Kamaruddin AF, Shafiai NAAJJoH, Medicine T. Investigation of the prevalence of skeletal patterns in the malay population using anb angle and principal component analysis of cephalometric variables. Complementary Therapy, Diagnostic and Advanced Material in Medical and Dentistry 2023(Special Issue 1):226-34.
39. Paddenberg E, Proff P, Kirschneck C. Floating norms for individualising the ANB angle and the WITS appraisal in orthodontic cephalometric analysis based on guiding variables. Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 2023;84(1):10-8.
40. Satwik A, Naveed N. Third molar impaction-review. Research Journal of Pharmacy and Technology. 2014;7:1498-500.
41. Bhullar M, Thakur A, Mittal S, Aggarwal I, Palkit T, Goyal M. Evaluation and Correlation of Beta Angle with Wits Appraisal and ANB Angle in Various Skeletal Malocclusion Groups—A Cephalometric Study. Dental Journal of Advance Studies. 2021;9.
42. Breik O, Grubor D. The incidence of mandibular third molar impactions in different skeletal face types. Australian dental journal. 2008;53(4):320-4.
43. Panda S, Sharma K. Mandibular third molar impaction in different facial growth patterns. Rama Univ J Dent Sci. 2018;5:8-6.
44. Abu Alhaija ES, AlBhairan HM, AlKhateeb SN. Mandibular third molar space in different antero-posterior skeletal patterns. European journal of orthodontics. 2011;33(5):570-6.
45. Bin Rubaia'an MA, Neyaz A, Talic F, Alkhamis A, Alghabban A, Assari A. The Association Between Skeletal Facial Types and Third Molars Impaction in a Saudi Arabian Subpopulation: A CBCT Study. Clinical, cosmetic and investigational dentistry. 2023;15:143-56.
2. Ishwarkumar S, Pillay P, Haffajee M, Satyapal K. Prevalence of impacted third molars in the South African Indian population of the eThekwini Metropolitan Region. South African Dental Journal. 2019;74.
3. Idris AM, Al-Mashraqi AA, Abidi NH, Vani NV, Elamin EI, Khubrani YH, et al. Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation. The Saudi dental journal. 2021;33(4):194-200.
4. Bamdadianf T. Evaluation of impact teeth prevalence and related pathologic lesions in patients in Northern part of Iran (2014-2016). J Contemp Med Sci| Vol. 2018;4(1):30-2.
5. Kan KW, Liu JK, Lo EC, Corbet EF, Leung WK. Residual periodontal defects distal to the mandibular second molar 6–36 months after impacted third molar extraction: A retrospective cross‐sectional study of young adults. Journal of clinical periodontology. 2002;29(11):1004-11.
6. Motonobu A, Hidemichi Y, Eri U, Takashi T, Kenichi K. Cohort study of pain symptoms and management following impacted mandibular third molar extraction. Oral Diseases. 2017;23(1):78-83.
7. Celikoglu M, Kamak H. Patterns of third-molar agenesis in an orthodontic patient population with different skeletal malocclusions. The Angle orthodontist. 2012;82(1):165-9.
8. Sifuentes-Cervantes JS, Carrillo-Morales F, Castro-Núñez J, Cunningham LL, Van Sickels JE. Third molar surgery: Past, present, and the future. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021;132(5):523-31.
9. Vranckx M, Fieuws S, Jacobs R, Politis C. Prophylactic vs. symptomatic third molar removal: Effects on patient postoperative morbidity. Journal of Evidence Based Dental Practice. 2021;21(3):101582.
10. Khouri C, Aoun G, Khouri C, Saade M, Salameh Z, Berberi A, et al. Evaluation of third molar impaction distribution and patterns in a sample of Lebanese population. Journal of Maxillofacial. 2022:1-9.
11. Riedel RA. A review of the retention problem. The Angle Orthodontist. 1960;30(4):179-99.
12. Tassoker M, Kok H, Sener S. Is there a possible association between skeletal face types and third molar impaction? A retrospective radiographic study. Medical Principles and Practice. 2019;28(1):70-4.
13. Yilmaz S, Adisen MZ, Misirlioglu M, Yorubulut S. Assessment of third molar impaction pattern and associated clinical symptoms in a central anatolian turkish population. Medical Principles and Practice. 2016;25(2):169-75.
14. Joshi N, Hamdan AM, Fakhouri WD. Skeletal malocclusion: a developmental disorder with a life-long morbidity. Journal of clinical medicine research. 2014;6(6):399-408.
15. Husain S, Rengalakshmi S. Correlation between mandibular third molar and mandibular incisor crowding: A retrospective CBCT-based study. J Dent Res Dent Clin Dent Prospects. 2021;15(4):247-50.
16. Palikaraki G, Mitsea A, Sifakakis I. Effect of mandibular third molars on crowding of mandibular teeth in patients with or without previous orthodontic treatment: a systematic review and meta-analysis. Angle Orthod. 2024;94(1):122-32.
17. Gokalp H, Erdem M. Assessing position changes of impacted third molars in treatment of class II malocclusion with premolars extraction. Acta odontologica Scandinavica. 2024;83:582-7.
18. Shokri A, Mahmoudzadeh M, Baharvand M, Mortazavi H, Faradmal J, Khajeh S, et al. Position of impacted mandibular third molar in different skeletal facial types: First radiographic evaluation in a group of Iranian patients. Imaging science in dentistry. 2014;44(1):61-5.
19. Hassan AH. Pattern of third molar impaction in a Saudi population. Clinical, cosmetic and investigational dentistry. 2010;2:109-13.
20. Novianty S, Melynda V, Yusuf M, Putranto R. The Relationship of Facial Soft Tissue A’N’B Angle and Facial Hard Tissue ANB Angle in Determination of Skeletal Relations. Odonto : Dental Journal. 2023;10:34.
21. Gasgoos S, Saleem N, Awni K. Cephalometric features of skeletal Class I, II and III (A comparative study). Al-Rafidain Dental Journal. 2007;7:122-30.
22. Cortell-Ballester I, Almendros-Marqués N, Berini-Aytés L, Gay-Escoda C. Validation of a computer-assisted system on classifying lower third molars. Medicina oral, patologia oral y cirugia bucal. 2011;16(1):e68-73.
23. Prajapati VK, Mitra R, Vinayak KM. Pattern of mandibular third molar impaction and its association to caries in mandibular second molar: A clinical variant. Dental research journal. 2017;14(2):137-42.
24. Aryan Hesam A, Seyed Morteza S, Reza G. Molar impaction patterns and skeletal malocclusions. Journal of Craniomaxillofacial Research. 2022;8(4).
25. Sivaramakrishnan SM, Ramani P. Study on the prevalence of eruption status of third molars in South Indian population. Biology and Medicine. 2015;7.
26. Al-Anqudi SM, Al-Sudairy S, Al-Hosni A, Al-Maniri AJSQUMJ. Prevalence and pattern of third molar impaction: a retrospective study of radiographs in Oman. 2014;14(3):e388.
27. Al-Madani SO, Jaber M, Prasad P, Maslamani MJMA. The Patterns of Impacted Third Molars and Their Associated Pathologies: A Retrospective Observational Study of 704 Patients. 2024;13(2):330.
28. Syed KB, Zaheer KB, Ibrahim M, Bagi MA, Assiri MAJJoiohJ. Prevalence of impacted molar teeth among Saudi population in Asir region, Saudi Arabia–a retrospective study of 3 years. 2013;5(1):43.
29. Gupta S, Bhowate RR, Nigam N, Saxena SJISRN. Evaluation of impacted mandibular third molars by panoramic radiography. 2011;2011(1):406714.
30. Jung YH, Cho BH. Prevalence of missing and impacted third molars in adults aged 25 years and above. Imaging science in dentistry. 2013;43(4):219-25.
31. Singh P, Nath P, Bindra S, Rao SS, Reddy KVR. The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study. National journal of maxillofacial surgery. 2018;9(2):215-21.
32. Ryalat S, AlRyalat SA, Kassob Z, Hassona Y, Al-Shayyab MH, Sawair F. Impaction of lower third molars and their association with age: radiological perspectives. BMC oral health. 2018;18(1):58.
33. Passi D, Singh G, Dutta S, Srivastava D, Chandra L, Mishra S, et al. Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study. National journal of maxillofacial surgery. 2019;10(1):59-67.
34. Hashemipour MA, Tahmasbi-Arashlow M, Fahimi-Hanzaei F. Incidence of impacted mandibular and maxillary third molars: a radiographic study in a Southeast Iran population. Medicina oral, patologia oral y cirugia bucal. 2013;18(1):e140-5.
35. Alfadil L, Almajed E. Prevalence of impacted third molars and the reason for extraction in Saudi Arabia. The Saudi dental journal. 2020;32(5):262-8.
36. Carter K, Worthington S. Predictors of Third Molar Impaction: A Systematic Review and Meta-analysis. Journal of dental research. 2016;95(3):267-76.
37. Aldrees AM. Pattern of skeletal and dental malocclusions in Saudi orthodontic patients. Saudi medical journal. 2012;33(3):315-20.
38. Ran ALY, Kamaruddin AF, Shafiai NAAJJoH, Medicine T. Investigation of the prevalence of skeletal patterns in the malay population using anb angle and principal component analysis of cephalometric variables. Complementary Therapy, Diagnostic and Advanced Material in Medical and Dentistry 2023(Special Issue 1):226-34.
39. Paddenberg E, Proff P, Kirschneck C. Floating norms for individualising the ANB angle and the WITS appraisal in orthodontic cephalometric analysis based on guiding variables. Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 2023;84(1):10-8.
40. Satwik A, Naveed N. Third molar impaction-review. Research Journal of Pharmacy and Technology. 2014;7:1498-500.
41. Bhullar M, Thakur A, Mittal S, Aggarwal I, Palkit T, Goyal M. Evaluation and Correlation of Beta Angle with Wits Appraisal and ANB Angle in Various Skeletal Malocclusion Groups—A Cephalometric Study. Dental Journal of Advance Studies. 2021;9.
42. Breik O, Grubor D. The incidence of mandibular third molar impactions in different skeletal face types. Australian dental journal. 2008;53(4):320-4.
43. Panda S, Sharma K. Mandibular third molar impaction in different facial growth patterns. Rama Univ J Dent Sci. 2018;5:8-6.
44. Abu Alhaija ES, AlBhairan HM, AlKhateeb SN. Mandibular third molar space in different antero-posterior skeletal patterns. European journal of orthodontics. 2011;33(5):570-6.
45. Bin Rubaia'an MA, Neyaz A, Talic F, Alkhamis A, Alghabban A, Assari A. The Association Between Skeletal Facial Types and Third Molars Impaction in a Saudi Arabian Subpopulation: A CBCT Study. Clinical, cosmetic and investigational dentistry. 2023;15:143-56.
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| Issue | Vol 12, No 3 (Summer 2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Third molar impaction; Orthodontic patients; Skeletal malocclusion. | ||
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How to Cite
1.
Azizi M, Ataie A, Azizi M, Hojati NS, Zamaninasab Z. Evaluation of Third Molar Impaction Pattern in Orthodontic Patients with Different Skeletal Malocclusion, Southeast Iran. J Craniomaxillofac Res. 2025;12(3):168-176.
